Week 4 - Anatomy of Surgical Incisions

Question 1

A vertical midline incision is most likely to be used for what procedure?

Answer 1

Laparotomy

Question 2

A suprapubic incision is most likely to be used for which procedures?

Answer 2

Lower segment C-section or abdominal hysterectomy

Question 3

A subumbilical incision is most likely to be used for what procedure? What may also be seen alongside this incision?

Answer 3

Laparoscopy / lateral port sites

Question 4

The direction of cut for a surgical incision should ideally follow what if possible?

Answer 4

Langer lines

Question 5

What are the layers of the lateral aspect of the anterolateral abdominal wall from outer to inner?

Answer 5

Skin, superficial fascia, external oblique, internal oblique, transversus abdominus

Question 6

What are the layers of the anterior aspect of the anterolateral abdominal wall from outer to inner?

Answer 6

Skin, superficial fascia, rectus sheath, rectus abdominus

Question 7

The external oblique muscle attaches between where?

Answer 7

The lower ribs and the iliac crest/pubic tubercle/linea alba

Question 8

What is the linea alba?

Answer 8

A midline blending of aponeuroses

Question 9

Fibres of the external oblique muscles run in the same direction as what?

Answer 9

External intercostal muscles

Question 10

The internal oblique muscles attach between where?

Answer 10

The lower ribs, thoracolumbar fascia, iliac crest and the linea alba

Question 11

Fibres of the internal oblique muscles run in the same direction as what?

Answer 11

Internal intercostal muscles

Question 12

The transversus abdominus muscles attach between where?

Answer 12

The lower ribs, thoracolumbar fascia, iliac crest and the linea alba

Question 13

Which anterolateral abdominal wall muscle has tendinous intersections?

Answer 13

Rectus abdominus

Question 14

What is the function of the tendinous intersections of the rectus abdominus muscle?

Answer 14

Divides it into smaller muscles for improved mechanical efficiency

Question 15

The linea alba runs from where to where?

Answer 15

Xiphoid process of the sternum to the pubic symphysis

Question 16

What is the significance of stitching closed the rectus sheath after an operation?

Answer 16

Improves wound healing and reduces the risk of wound complications

Question 17

The rectus sheath is found immediately deep to what?

Answer 17

The superficial fascia

Question 18

What is the rectus sheath?

Answer 18

A combined aponeurosis of the anterolateral abdominal wall muscles

Question 19

The rectus sheath surrounds which structure?

Answer 19

The rectus abdominus muscle

Question 20

When undertaking a suprapubic incision, only which aspect of the rectus sheath is cut?

Answer 20

Anterior rectus sheath

Question 21

The nerve supply to the anterolateral abdominal wall enters in what direction?

Answer 21

Lateral

Question 22

What are the main nerve supplies to the anterolateral abdominal wall?

Answer 22

7th-11th intercostal nerves (as the thoracoabdominal nerves), subcostal nerves, ilioinguinal and iliohypogastric nerves

Question 23

Where do the nerves supplying the anterolateral abdominal wall travel between?

Answer 23

The plane between the internal obliques and transversus abdominus’

Question 24

What are the 2 arteries supplying blood to the anterior abdominal wall?

Answer 24

Superior and inferior epigastric arteries

Question 25

The superior epigastric arteries are a continuation of what arteries?

Answer 25

Internal thoracic arteries

Question 26

Which arteries supplying the anterior abdominal wall emerges at its superior aspects?

Answer 26

Superior epigastric arteries

Question 27

Where do the superior and inferior epigastric arteries lie?

Answer 27

Posterior to the rectus abdominus

Question 28

The inferior epigastric arteries are a branch of what?

Answer 28

External iliac arteries

Question 29

Which arteries supplying the anterior abdominal wall emerges at its inferior aspects?

Answer 29

Inferior epigastric arteries

Question 30

Which arteries supply blood to the lateral abdominal wall?

Answer 30

Intercostal and subcostal arteries

Question 31

Intercostal and subcostal arteries are continuations of what?

Answer 31

Posterior intercostal arteries

Question 32

When incising muscle, what is the best way to minimise traumatic injury to the muscle fibres?

Answer 32

Incise in the same direction as muscle fibres

Question 33

What happens to the rectus muscles in a LSCS?

Answer 33

They are not cut, they are separated from each other in a lateral direction

Question 34

A vertical midline incision is relatively bloodless - what is the significance of this?

Answer 34

Can mean that healing is not as good and increases the chance of wound complications

Question 35

If a lateral port is required for a laparoscopy, care must be taken to avoid which structure?

Answer 35

Inferior epigastric artery

Question 36

Where does the inferior epigastric artery arise?

Answer 36

Just medial to the deep inguinal ring

Question 37

From its emergence just medial to the deep inguinal ring, in which direction does the inferior epigastric artery travel to reach the rectus abdominus?

Answer 37

Superomedial

Question 38

How can the pelvic organs be viewed during laparoscopy?

Answer 38

By manipulating the position of the uterus by grasping the cervix with forceps inserted through the vagina

Question 39

During a hysterectomy, extreme care must be taken to differentiate what two structures?

Answer 39

Ureter and uterine artery

Question 40

How can you tell the difference between the ureter and the uterine artery?

Answer 40

The ureter passes inferior to the artery / the ureter will vermiculate when touched